An alternative management for growth retarded fetus with absent end-diastolic velocity in umbilical artery and normal cardiotocography.

OBJECTIVES: Intrauterine growth retardation (IUGR) is associated with fetal adverse conditions. The most important cause of growth restriction and poor perinatal outcome is chronic fetal hypoxemia (CFH). Adaptation to CFH can be studied by Doppler velocity waveform on umbilical and fetal arteries and cardiotocography (CTG).

METHODS: Preterm delivery, as an elimination of CFH, has to be confronted with the risks of prematurity. A special situation may occur when CTG is normal at the absence of end-diastolic velocity (AEDV). AEDV in the umbilical artery precedes the onset of abnormal CTG, whose duration differs considerably among the fetuses. The time after the onset of AEDV in pregnancy may be utilized for performing exact diagnosis by fetal blood analysis.

CASE: Primigravida at 30 gestational weeks was referred because of IUGR. IUGR, AEDV, oligohydramnion, and normal fetal anatomy were revealed. CTG was normal. Indication for cordocentesis was to perform cord blood gases analysis and to obtain fetal caryotype. Cordocentesis revealed normal caryotype, values of pH, and fetal blood gases were considered satisfactory. Continuation of pregnancy was decided in spite of persistent AEDV. At 33 gestational weeks pathological CTG was an indication for induction of labor. Labor, delivery, umbilical blood gases, postpartal and neonatal outcome were normal.

CONCLUSION: In the case of fetal monitoring controversy assessment of umbilical blood analysis may be crucial. This examination is significant and independent of the interval between cordocentesis and the onset of CTG pathology. This interval may be utilized for intrauterine treatment and for optimizing obstetric management.